Provider Demographics
NPI:1134331473
Name:HERNANDEZ, SALVADOR JR (IDC)
Entity Type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051
Mailing Address - Country:US
Mailing Address - Phone:181-535-4335
Mailing Address - Fax:
Practice Address - Street 1:ATG WP PSC 473 BX 16
Practice Address - Street 2:ENG DEPT.
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:96349
Practice Address - Country:JP
Practice Address - Phone:243-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman